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3.2.1 Collate documents and correspond with the licensing authority:
a) Described the process for collating the documents and assembling them to send to the Licensing
Authority.
b)
State requirements for documentation and communication with Licensing Authority.
c)
State requirements imposed by the Licensing Authority for review or audit of medical examinations.
d) Describe the process for participating in review or audit.
3.2.2 Communicate and store information as required:
a) Describe the requirements for communicating with the Licensing Authority, the applicant, and any
other applicable party.
b) Describe how to reference the data protection/privacy requirements which apply to medical
examination records.
c) Describe the processes for protecting and securing records.
d) Describe to whom records may be released, and under what circumstances.
ICAO Preliminary Unedited Version — May 2010 V-1A-1
APPENDIX. SUGGESTED MINIMUM FOUNDATION KNOWLEDGE
REQUIRED FOR MEDICAL EXAMINER
As explained earlier, all examiners will be involved to some extent in making decisions around medical
conditions. To do this the medical examiner must build on a sound understanding of the regulatory
framework, responsibilities and accountabilities, including the process of flexibility as per paragraph 1.2.4.9
of Annex 1. This will be achieved by employing knowledge of clinical aviation medicine, taking into account
aspects of risk management.
As background for evaluating aeromedical issues, examiners need to learn about the psychological and
physiological challenges of flight. The following summary is suggested as a reasonable basis of knowledge to
support the specific competencies in the framework above. These subjects could be taught in a knowledgebased
manner rather or as part of a competency-based programme.
Aviation physiology
Cognition and commercial aviation
Decision making and communication in aviation
Sleep and fatigue as related to commercial aviation
Physics of the atmosphere; effects of altitude on trapped gas
Effects of hypoxia
Functional aspects of vision relevant to aviation
Spatial disorientation
Effects of acceleration
Clinical aviation medicine
Aspects of incapacitation in flight
Effects of ageing as related to flight safety
Cardiological conditions relevant to flight
Neurological conditions relevant to flight
Ophthalmological conditions relevant to flight
Ear/nose/throat conditions relevant to flight
Respiratory conditions relevant to flight
Psychiatric conditions relevant to flight
Metabolic/endocrine conditions relevant to flight
Other conditions relevant to flight (digestive, haematological, urinary, renal, gynaecological/obstetric,
musculoskeletal, infective, malignant)
Medication relevant to flight
Regulatory Medicine
ICAO Standards and Recommended Practices
Licensing concepts and types
ICAO Annex 1, documents, certificates and validity periods
Application of 1.2.4.8 -Flexibility and accredited medical conclusion
Evaluation of evidence – critical appraisal of specialist reports and data
Decrease in medical fitness
Other medical regulations in the ICAO Annexes (psychoactive substances, fatigue, oxygen)
Principles of risk management
ICAO Preliminary Unedited Version — May 2010 V-1A-2
REFERENCES
1. About USPSTF. U.S. Preventive Services Task Force, January 2010. Agency for Healthcare
Research and Quality. Rockville, MD. http://www.arhq.gov/clinic
2. Barette-Sabourin N. Developing competency-based training and performance standards for
licensing flight crew members: a progress report. Presentation to TrainAir Panel Meeting. Montreal:
ICAO, 2004
3. Booze CF Jnr. Sudden inflight incapacitation in general aviation. Aviat Space Envir Med 1989;
60:332-5.
4. Canfield DV, Salazar GJ, Lewis RJ, Winnery JE. Pilot medical history and medications found in
post-mortem specimens from aviation accidents. Aviat Space Envir Med 2006; 77:1171-3.
5. Chapman P. The consequences of in-flight incapacitation in civil aviation. Aviat Space Envir Med
1984; 55:497-500.
6. DeJohn CA, Wolbrink AM, Larcher JG. In-flight medical incapacitation and impairment of US
airline pilots: 1993 to 1998. 2004. FAA technical report DOT/FAA/AM-04/16.
7. Evans AD, Watson DB, Evans SA, Hastings J, Singh J, Thibeault C. Safety management as a
foundation for evidence-based aeromedical standards and reporting of medical events. Aviat Space
Environ Med 2009; 80:511-5.
8. Evans AD. International regulation of medical standards. In Rainford DJ and Gradwell DP
Ernsting’s Aviation Medicine (4th Ed), 2006.
9. Evans AD. Examining the professional pilot: can we do better? Presentation to UK Association of
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Manual of Civil Aviation Medicine 2(158)
